When Joints Get Replaced

Margaret, 84, has a packed schedule. As a very active member and volunteer at a large seniors’ centre in Ottawa, Margaret takes public transit back and forth to the centre four times a week. With the harsh weather fluctuations, this can be a challenge regardless of age. But the only thing that has ever stopped Margaret’s regular routine is the pain that restricted her mobility before a joint replacement surgery and during the recovery period afterward.

Margaret has had the same number of joint replacements as she has grandchildren: seven. They have come in the past few decades of her 47 years here in Canada (after emigrating from Scotland). She is fortunate, as having nearby family meant she could recover from those operations, where possible, at home with the help of loved ones.

“The knees were the easiest recovery, while the ankle took the longest because I couldn’t put any weight on it for six weeks,” she said. “I was entirely dependent on others for getting dressed and washed and other basic necessities.”

Similar to Australia and the U.K., Canada has a national registry—CIHI’s Canadian Joint Replacement Registry(CJRR)—to track these types of surgery. According to the latest report, there were 93,446 hospitalizations for all hip and knee replacements in Canada in 2010–2011—an increase of 13% from five years earlier. The increase was highest in Nova Scotia, where the five-year rates of hip and knee replacements surged 26% and 59%, respectively.

While osteoarthritis is the most common cause of hip and knee replacement surgery, Margaret’s problem is rheumatoid arthritis. In the past 15 years, this autoimmune disease has resulted in joint replacements for both sets of hips, knees and shoulders, as well as her left ankle.

Because surgery is a serious experience for individuals, particularly those of retirement age, the ultimate aim of CJRR is to improve clinical outcomes and reduce the need for a revision (repeat) surgery. One recent report by CIHI investigated several factors—including the type of implant surface used—on the risk of needing a repeat hip surgery. It found that certain types of metal-on-metal hip replacements run a greater risk of needing revision surgery, a finding consistent with international registries and medical literature.

Fortunately, of Margaret’s seven procedures, none was a repeat. This has likely helped her maintain her health, independence and good quality of life. “You have to keep moving, especially with joint replacements,” she said.

CIHI is attempting to track all Canadians who need to replace their joints. Thus far, B.C., Manitoba and Ontario have mandated reporting to CJRR. Elsewhere, surgeons and hospitals voluntarily submit data, except in P.E.I., which does not currently participate.

“With increasing national coverage, our registry will be better positioned to help provide important information for health care providers, governments and Canadians regarding what generates better outcomes for these common procedures,” said Greg Webster, CIHI’s Director of Acute and Ambulatory Care Information Services.

Consider this: By 2031, 7 million Canadians—one in five people—will have arthritis (according to The Arthritis Society). Ensuring safe and effective joint replacements will only escalate in importance.

And people like Margaret will be able to maintain their active schedules.